Glaucoma is a generic term for a variety of conditions that lead to an abnormal elevation of intraocular pressure (IOP). This can cause irreversible damage to the nerve fibers and makes glaucoma a leading cause for blindness.
Some of these conditions can be inherited. In other cases, they can occur as a consequence of trauma, inflammation, and even medications such as corticosteroids.
- Family history, such as having a first-degree relative with a history of glaucoma
- Ethnic background
- Primary open glaucoma is more prevalent in African Americans
- Narrow angles are more prevalent in Asians
- Pseudo exfoliation, an abnormal production of an intra ocular material that can cause glaucoma, is more prevalent in people with Scandinavian ancestry
A history of ocular trauma
- blunt ocular trauma can damage to the drainage system of the eye, a condition known as angle recession glaucoma
- Steroids in any form can cause an abnormal elevation of the IOP that may lead to glaucoma
- Certain antidepressants can cause acute angle closure glaucoma
- Medications that induce dilation of the pupils as well as antihistamines used to treat allergy can cause acute angle closure glaucoma
- A history of cardiovascular disease, such as hypertension or diabetes
- A history of migraines
- Certain systemic inflammatory diseases can lead to glaucoma by either causing inflammation of the eyes, or as a side effect of the steroids required for their treatment
- Glaucoma is more frequently seen as we age
- The American Academy of Ophthalmology recommends an annual examination after the age of 50
- Being farsighted or nearsighted may increase your risk for different types of glaucoma
There are several other known risk factors, but these are the most common
What are the symptoms of Glaucoma?
Most people with glaucoma do not feel any symptoms until the disease is very advanced and they have permanently lost a significant amount of vision.
Although less common than other types of glaucoma, acute angle closure glaucoma may cause sudden, intense, decreased vision as well as nausea and vomiting. Although it is rare, it can be devastating and must be treated immediately.
How is Glaucoma diagnosed?
Prevention is key. If you have any of the risk factors mentioned above, you should consult with an ophthalmologist and get a detailed assessment including measurement of the intraocular pressure and a thorough examination of the eyes. If there is any suspicion of glaucoma, other, more specialized tests will be performed.
There are different treatment options, including medications, usually in the form of drops, laser treatments, or surgery.
Choosing the right treatment strategy frequently requires more than one visit, and the doctor may change or make adjustments to the initial plan depending on how you respond to treatment.
How do treatments work?
All treatments; medications, lasers, or surgical procedures, are focused on decreasing the IOP by either increasing the outflow or decreasing the production of fluid within the eye.
My intraocular pressure was found to be abnormal; do I have glaucoma?
Not necessarily. You might have Ocular Hypertension. This is a condition in which the IOP is abnormally elevated, but there is no noticeable damage to the optic nerves. Depending on the degree of pressure elevation and the presence of other risk factors, we may offer you the option of observation without treatment, which involves periodic follow up visits.
I have been diagnosed with glaucoma.
Which form of treatment is the best for me?
Treatment selection is highly individualized and requires consideration of multiple factors, including the amount of damage at the time of diagnosis, age, existence of other ocular or systemic conditions, and even social factors such access to care or medications, and the ability to comply with treatment.
Can treatment restore my sight?
Not yet. However, promising results with ongoing stem cell research will eventually allow for the restoration of damaged optic nerve cells.
I have been told that I have “narrow angles.” What does that mean, and do I have glaucoma?
The “angle” refers to an important area of the outflow system of the eye, located where the cornea meets the iris. If the angle closes, pressure will build up and may cause glaucoma.
Having a narrow angle does not necessarily mean that you have glaucoma, however, it may put you at risk for developing an acute angle closure attack. If your angle is very narrow, a preventive laser treatment called an iridotomy may be indicated.
My doctor offered laser surgery as a first option, is that OK?
Possibly. If you have very narrow angles, a laser iridotomy or LPI, may prevent an angle closure attack. If you have open angle glaucoma, a laser procedure called Selective Laser Trabeculoplasty or SLT, can be used to increase the outflow of fluid from the eye. SLT can be as effective as medications, but without their associated side effects and long term costs.
What is glaucoma surgery like?
There are multiple surgical options available to treat glaucoma. For many years, the most common surgical technique for treating glaucoma has been a procedure called Trabeculectomy. It consists of using the natural tissues of the eye to create a valve-like pathway. Other commonly used techniques include implantable devices that drain fluid from the eye. These techniques are reserved for more severe stages of glaucoma.
What is MIGS?
MIGS is an acronym that includes a variety of surgical techniques and microscopic devices used for minimally invasive glaucoma surgery. There are several different devices used for MIGS currently approved for use in the United States, and there are continuous efforts to develop and approve many more.
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